SUBSTANCE: one should study blood components to detect anticoagulant-fibrinolytic activity. Moreover, patient's blood should be sampled: in whole blood one should detect the presence of affected erythrocytes and evaluate the quantity of thrombocytes, in plasma it is necessary to study the activity of antithrombin III, XIIa-dependent fibrinolysis, the content of soluble fibrin-monomeric complexes, in blood serum of the sample taken one should detect the concentration of urea, creatinine, sodium, albumin, total cholesterol and the activity of aspartate aminotransferase, moreover, one should calculate integral value of renal-hepatic deficiency, to put corresponding point for the degree of parameters under testing, then one should calculate integral value of disseminated intravascular clotting (IVDIC) and at its value being 6.3 U and more DIC-syndrome should be diagnosed, moreover, at IVDIC value ranged 6.3-10.1 U it is possible to diagnose latent DIC-syndrome, at 10.2-14.6 - subacute DIC-syndrome and at 14.7 and higher - acute DIC-syndrome should be concluded.

EFFECT: higher accuracy and efficiency of diagnostics.

4 ex, 2 tbl

The invention relates to medicine, more specifically, to methods of diagnosing disseminated intravascular coagulation (DIC) and can be used by medical combustiologists and medical technicians for the early detection of this complication in patients with thermal injury.

The diagnosis of DIC assess the totality of the results of various laboratory methods of analysis, and then make a judgment about the depth hemostatic disorders (encyclopedia of clinical laboratory tests / edited Nautica. TRANS. with ang. edited Riv. M: Labelform, 1997. - 960 C.). The result of this overall assessment of disparate results based on the data from laboratory tests largely subjective and depends largely on the knowledge and experience of the Clinician.

Closest to the proposed technical solution is a method of diagnosis of DIC is based on the results of a study of blood components and determine its anticoagulant-fibrinolytic activity, which are described in the monograph Tshwaragano and Appamada (Basis of diagnosis of disorders of hemostasis. - M.: Novamed, 1999. - 224 S.). However, in this case the results are not merged into the index, making it difficult to objectively diagnose DIC, it is not possible if the natural enemy can Express the depth of hemostatic disorders with complication (to determine the severity of the syndrome DIC),
to monitor its dynamics during treatment of the patient, promptly appoint an adequate therapeutic measures.

The present invention is to eliminate the existing shortcomings - the creation of an integrated indicator based on laboratory analysis of blood for objectification and rapid diagnosis of disseminated intravascular coagulation.

The problem is solved due to the fact that in patients with burns away the blood and using the known methods in whole blood to determine the presence of damaged erythrocytes, estimate the number of platelets, plasma investigate the activity of anti-thrombin III (AT III), XIIa-dependent fibrinolysis (XIIa-PD), the content of soluble fibrin-monomer complexes (; fibrin monomer complex), in the serum sample to determine the concentration of urea, creatinine, sodium, albumin, total cholesterol and the activity of aspartate aminotransferase, calculate the integral indicator of renal-hepatic insufficiency, the severity of identified parameters is assigned a corresponding score (table 1)calculate the integral indicator of disseminated intravascular coagulation (IPDS) by the formula:

IPDS=ABOVE+COMMITMENT+B+IV+V+VI, where

ABOVE is the number of points activity of anti-thrombin III from 1 to 5,

COMMITMENT - XIIa activity-dependent febrina is for from 1 to 5,

B content of soluble fibrin-monomer complexes from 1 to 5,

IV - platelet count from 1 to 5,

V - test damage of erythrocytes from 0 to 3,

VI - integral indicator of renal-hepatic insufficiency from 1 to 5,

and when is IPDUS of 6.3% and above diagnosed with DIC, and when is IPDUS in the range from 6.3 to 10.1% diagnose latent DIC, from 10.2 to 14.6 - subacute DIC, and from 14.7 and above with acute disseminated intravascular coagulation. When the rate of 6.2% and lower the probability of the presence of DIC is rejected.

The method is as follows. In patients with burns from the cubital vein to take blood and put in 3 test tubes for preparation of plasma (1 test tube), the sample for counting the number of platelets (2nd tube) and serum (3 tube). In the obtained samples using known methods to determine the parameters characterizing the state of hemostasis (1 tube) - the activity of AT III (fall activity AT III - main endogenous anticoagulant indicates a depletion of the link mechanism of the regulation of hemostasis, and the continuing decline - progression DIC); activity Ha PD (value Ha PD reflects the state of the main loft is built of proteolytic systems;
the increase in time of lysis euglobulin clot indicates a slowdown of this process; the deepening of DIC is accompanied by an increase in this figure); contents; fibrin monomer complex with orthophenanthroline test (increase; fibrin monomer complex is an indication of increasing blood depolymerizes "locked" fibrin-monomer complexes, which is a marker of DIC).

The number of platelets examined in vitro 2. Thrombocytopenia when DIC is a consequence of their consumption (platelet aggregation in the microthrombi). Sharply increasing thrombocytopenia indicates the progression of the syndrome of ice.

Whole blood for the detection of damaged erythrocytes (test for damaged red blood cells) taken from the tube 1 until the separation of plasma from red blood cells. The allocation of damaged red blood cells is carried out in the capillary on the solution urografin a given density. A positive test for damaged erythrocytes characterized by the activation of intravascular coagulation. Damage (fragmentation) of erythrocytes by passing them through microvessels, blocked threads of fibrin is formed from fibrinogen under the influence of proteolytic enzyme thrombin.

Determine the concentration of urea, creatinine, sodium, albumin, total cholesterol and aktivnosti aspartate aminotransferase (tube 3).
The integral indicator of renal-hepatic insufficiency (IPPN), reflecting the depth of multiorgan disorders arising in the process of development of DIC due to macrothrombocytopenia vessels parenchymatous organs, disorders of microcirculation, hypoxia and subsequent failure of their function, calculated by the formula

IPPN=(C1+C2+C3+C4)/(K5+C6), where

K1- the ratio of the concentration of urea in the serum of the patient to the average content of the analyte healthy people;

K2- the ratio of the concentration of creatinine in the serum of the patient to the average content of the analyte healthy people;

To3- the ratio of the concentration of sodium in the serum of the patient to the average content of the analyte healthy people;

To4- the ratio of aspartate aminotransferase activity in serum of the patient to the average activity of the analyte healthy people;

K5the content of albumin in the serum of the patient to the average content of the analyte healthy people;

To6- the ratio of the content of total cholesterol in the serum of the patient to the average content of the analyte healthy people.

The results of each test rankings the Ute,
that is, a specific value of the analyzed indicator is assigned a corresponding score, the magnitude of which increases as the deepening of disorders of one or another element of the analyzed system, guided by the data in table 1. Calculate the integral indicator (IPDS) for the diagnosis of DIC by the formula

IPDS=ABOVE+COMMITMENT+B+IV+V+VI,

where ABOVE - the number of points activity of ATIII from 1 to 5,

COMMITMENT - activity Ha-f from 1 to 5,

B content; fibrin monomer complex from 1 to 5,

IV - platelet count from 1 to 5,

V - test damage of erythrocytes from 0 to 3,

VI - integral indicator of renal-hepatic insufficiency from 1 to 5,

and when is IPDUS of 6.3% and above diagnose DIC. IPDS in the range from 6.3 to 10.1% indicates the development of the patient latent (mild) form of DIC, from 10.2 to 14.6 - subacute (moderate) syndrome internal combustion engine, and when the value of the index from 14.7 and above - acute (severe) disseminated intravascular coagulation. The value of 6.2% and below allows you to reject the diagnosis of DIC.

The basis for determining the value of IPDS, above which it is possible judgment about the development of the patient DIC, was the results of a study of relevant indicators in patients receiving thermal injury and were treated in Rossick the m burn center on the basis of the Nizhny Novgorod research Institute of traumatology and orthopedics.
Lesions of the skin at the affected light burns did not exceed 20% of the body surface. Patients who received burns moderate, severe and very severe, had lesions of the skin over 20% of the body surface. Depth of burn was varied within II-AB-IV.

Surveyed 137 patients (297 definitions of IPDS during the observation period, patients with 1's on the 12th day after burn). Similar figures for calculation IPDS defined in healthy people (16 men, the control group). The results are shown in table 2.

Table 2The integral indicator value for the diagnosis of DIC (IPDS) in patients with burns, depending on the severity of thermal injury (c.u; M±m)

Healthy people (control)

Patients with burns (lesions of the skin less than 21%)

Patients with burns (lesions of the skin more than 21%)

1

2

3

5,4±0,18 (16*)

7,9±0,36 (21)p1<0,001

14,8±0,26 (276)p2<0,001p3<0,001

Notes: * in parentheses are number of definitions of IPDS; p
- significance of differences of the analyzed parameters in column 1 and 2, p2in 1 and 3, p3in gr and 3.

Is IPDS control was 5.4±0,19% (M±m, where M is the arithmetic mean, m is the average error of the arithmetic). This index varies in the range of 4.7 to 6.2% (M±δwhere δ - error arithmetic mean - Sigma). In patients with thermal injury averaged integral indicator for the diagnosis of DIC in patients with mild burns was 7,9±0,37% and in the group of patients who received burns moderate, severe and very severe - 14,8±0,26% Indicators varied in the range of 6.2 to 10.1 and 10.5-19.1% respectively (M±δ). With the aim of obtaining the highest accuracy and information content of the method of boundary IPDS, within which it is possible to adequately diagnose DIC and its shape (weight), were determined at different values of the coefficients of the mean-square deviation (M±0,67δ, 1δ, 1,5δ 2δ). Optimal for the correct diagnosis of DIC (or reject this diagnosis) was the scale of the analyzed parameters within M±δ in the group of healthy people and those suffering from thermal injury.

Since the upper bound of the range of IPDS in patients with mild burns ends at the value of 10.1%, the patients with more severe thermal injury to the lower boundary of the analyzed indicator starts with 10.5 units,
this limit should be lowered to 10.2% While the overall scale of values IPDS not interrupted.

It seems reasonable plot scale EPDS in the range of 10.2-19,1% should be divided equally. It should be assumed that patients with this index in the range from 10.2 to 14.6%, the severity of DIC is less pronounced than in patients with IPDS whose value varies from 14,7 to 19.1% and above. In this regard, DIC parameters of EPDS within 10,2-14,6% more should be classified as subacute (or moderate) DIC-syndrome, while when the metric value of 14.7% and more - mainly to acute (or heavy) the DIC syndrome. When identifying IPDS in the range of 6.3 to 10.1% diagnose latent (or easy) DIC, do not require special or emergency treatment, but implying adequate therapy of the underlying disease, however, disturbing the doctor in terms of careful observation of the hemostatic system of the patient in order to prevent the transition of latent forms of DIC in subacute.

Retrospective analysis of case histories of patients with thermal injury has allowed to test the proposed test is an integral index for the diagnosis of DIC. In the group of patients with burns over 20% of the body surface (117 people) latent DIC was diagnosed in 12 post is Adamchik,
subacute - 20, sharp - 50. Form of DIC in 34 patients has varied in the dynamics of metric observation from latent to subacute and acute, as well as from acute to subacute, that adequately reflect the peculiarities of the course of burn disease, deepening disorders, or, on the contrary, the system state restore hemostasis. One patient had IPDS within normal limits. In the group fired with mild thermal injury (burns less than 20% of body surface) of the 20 surveyed at 14 detected light DIC, 2 - subacute, and 4-x - norm.

Below are some examples to illustrate the proposed integrated indicator for the diagnosis of DIC (data retrospective analysis of case histories).

Example 1.

Patient f s A.I. 46 years (the East. b-nor 194632) arrived in Nizhny Novgorod research Institute of traumatology and orthopedics 19.11.2000, with scald I-II-AB extent on the area of 20% of the body surface. IPDS on the 1st day since thermal injury - 8 units, 2 days - 12%, 5th - 10 points, 8-e - 8 unit, 10-e - 9 unit According to IPDS - subacute DIC. The patient was discharged in satisfactory condition at 53-and the day after burn.

Example 2.

A patient With s N. 41 (East. b-nor 194557) received NIETO 14.11.2000, about burn the flame I-II-AB degree in the area of 40% body surface burn eyes I metro IPDS on the 1st day after injury - 12 unit, 2nd unit 14, 4th of 14 units, the 8th is the 14 units,
10 12 unit According to a study in IPDS - subacute DIC. The patient was discharged in good condition after 43 days after burn.

Example 3.

Patient B in SN. 41 (East. b-nor 195571) entered the Institute 31.01.01, with a burn with flame IIIB-IV degree in the area of 40% body surface burn of the upper respiratory tract and eyes. IPDS 1st day - 14 units, 2 days 21 units, 5th day - 21 units on the 7th day after burn despite aggressive treatment, the patient died. According to IPDS - acute DIC.

Example 4.

Victim X in AV 39 years (East. b-nor 186138). He entered the Russian burn center 07.04.99, with a burn with flame AB-IV degree on the area of 60% of the body surface. IPDS 1st day - 20%, 4th day - 22 units, 5-f - 22 unit On the 6th day the patient died. IPDS shows the development in a patient with acute DIC.

Thus, the proposed test for the diagnosis of DIC in patients with burns, as shown by the results of testing the method on a set of case histories of patients with thermal injury (retrospective analysis)adequately reflects the disorders of hemostasis and allows not only to detect DIC, but also to quantitatively characterize the depth of this pathological process. The latter is particularly important to study the dynamics of development of DIC and monitoring for research n the o drugs for the treatment of internal combustion engine,
statistical analysis that allows us to objectify the resulting findings and conclusions. An important advantage of the proposed method is its suitability for the diagnosis of DIC in any phase - Hyper - and gipokoagulyatsii, in the transition phase, as well as various form of its course (acute, subacute, latent). Along with the many tests that are performed during the examination of the patient, the doctor-combustible additionally receives one integral parameter characterizing the state of the hemostatic system that allows you to quickly assess the situation and make timely decisions on the appointment of a patient complex of those or other therapeutic measures aimed at the elimination of DIC syndrome. Use to retrieve the source data for calculation IPDS various modern analytical equipment (biochemical auto analyzer, the analyzer ion of blood, Hematology analyzer, analyzer for koagulologicheskih research) and independent from each other analytical methods, characterizing the link in the complex mechanism of pathogenesis of DIC syndrome, improves the accuracy of diagnosis of this complication and more objectively evaluate the patient's condition. All this, ultimately, allows us to recommend the method developed in clinics thermal lesions, and in which lineco diagnostic laboratories facility.

Method for the diagnosis of disseminated intravascular coagulation in burn disease through research blood components and definitions of anticoagulant-fibrinolytic activity, characterized in that the patient take the blood, whole blood to determine the presence of damaged red blood cells and estimate the number of platelets, plasma investigate the activity of anti-thrombin III, Ha-dependent fibrinolysis, the content of soluble hybridmonolith complexes in the serum sample to determine the concentration of urea, creatinine, sodium, albumin, total cholesterol and the activity of aspartate aminotransferase, calculate the integral indicator of renal-hepatic insufficiency, the severity of identified parameters is assigned a corresponding score, calculate the integral indicator of disseminated intravascular coagulation blood (IPDS) by the formula:

IPDS=ABOVE+COMMITMENT+B+IV+V+VI, where

ABOVE is the number of points activity of anti-thrombin III from 1 to 5,

COMMITMENT - activity Ha-dependent fibrinolysis from 1 to 5,

B - content soluble hybridmonolith complexes from 1 to 5,

IV - platelet count from 1 to 5,

V - test damage of erythrocytes from 0 to 3,

BVI is an integral indicator of renal-hepatic nedostatocno and from 1 to 5,

and when is IPDUS of 6.3% and above diagnosed with DIC, and when is IPDUS in the range from 6.3 to 10.1% diagnose latent DIC, from 10.2 to 14.6 - subacute DIC, and from 14.7 and above with acute disseminated intravascular coagulation.

SUBSTANCE: one should evaluate the time for clotting of plasma under testing in phospholipid-dependent test, moreover, one should apply high- and low-sensitive thromboplastin reagents to lupus anticoagulant to calculate the ratio of indices of prothrombin time prolongation and at its value being either equal to or above 1.1 one should diagnose APS.

SUBSTANCE: the suggested studying should be carried out on the glass simultaneously with several inductors by applying minimal inter-taking antilogarithms concentrations of aggregation inductors which correspond at double combination of inductors: ADP 5.0 x 10-8 M, adrenaline 3.0 x 10-9, collagen - dissolving the main suspension 1:8, thrombin 0.075 U/ml; at triple combination of inductors: ADP 10-9 M, adrenaline 10-9, collagen - dissolving the main suspension 1:9, thrombin 0.060 U/ml. The development of aggregation means thrombocytic activation in patients with arterial hypertension at metabolic syndrome. The method enables to evaluate the changes of thrombocytic functional state with combination of inductors more probably present in area of vascular lesion by applying minimal necessary concentrations that develops real conditions at hemostatic initiation in human vessels.

The invention relates to medicine, namely to methods assessment system gemokoagulyatsii, and can be used to determine changes in orientation of the coagulation potential of blood (Hyper - or hypocoagulation) in patients with DIC-syndrome

SUBSTANCE: one should analyze body values due to instrumental assay as cytomorphodensitometric technique to detect enzymatic activity of blood cells SDG and α-GPDG, calculate integral cytochemical index C for the activity of inflammatory process and C = 2.50 - 3.50 one should diagnose maximal degree of such activity, at C = 1.50 - 2.49 -moderate degree and at C = 0.50 - 1.49 - minimal degree of activity should be established in children against the norm (Cnorm = -0.50 - 0.49). The innovation shortens the time for prescribing adequate antiphlogistic therapy and specifies necessary duration of therapy course.

SUBSTANCE: one should detect the activity of myeloperoxidase (MP) and the content of cationic proteins (CP) in blood phagocytes and at CP content being above 105 c.u. at normal and increased MP activity one should diagnose sarcoidosis, and at CP content being below 105 c.u and decreased MP activity - pulmonary tuberculosis. The innovation provides more simplified way for differential diagnostics.

SUBSTANCE: it is developed that for patients having initially decreased by 31 % membrane fluidity in lymphocyte protein-lipid contact zone, increased by 103 % protein embedment into lymphocyte lipid matrix, decreased by 5-6 times K-coefficient (ratio of chemoluminescence light-sum to ceruleoplasmin in blood plasma) in contrast with respective indexes for healthy women high effectiveness of chemotherapy is predicted. On the other hand for patients having initially normal structural and functional state of blood cell membranes and K-value alteration by 3-3.5 times or less law effectiveness of chemotherapy is predicted.

EFFECT: simplified and accelerated method for prognosis of individual patient sensitivity to chemotherapy.

SUBSTANCE: method involves incubating sample with plasminogen, plasminogen-to-plasmin transformation stimulator under the tissular plasminogen adjuvant action and chromogenic synthetic plasmin substrate and determining tissular plasminogen adjuvant activity from substrate hydrolysis product concentration colored with the plasmin. Lys-plasminogen pretreated with pancreatic trypsin inhibitor or Glu-plasminogen is used as the plasminogen. Specific HCO-Ala-Phe-Lys-p-ntroanilide is applied as the plasmin substrate. Soluble fibrin-monomer produced by means of thrombine-like enzyme ancistrone from snake poison of is applied as the plasminogen-to-plasmin transformation stimulator under tissular plasminogen adjuvant action. Incubation is carried out at pH=7.0-8.5. The most optimum concentration for Lys- or Glu-plasminogen is equal to 0.3 mcM, and it is equal to 0.6 mM for the specific HCO-Ala-Phe-Lys-p-ntroanilide substrate, and 0.025 mg/ml for the fibrin-monomer.

SUBSTANCE: method involves isolating blood serum proteins and separating them into fractions by means of electrophoresis. Alpha-2-globulins and gamma-globulins content is determined in acute disease phase in percent ratio from total protein quantity. Then, changes in the fractions content is controlled from the first to the eighth week. Alpha-2-globulins content drop from 18% to a norm to the third or fourth week, and gamma-globulin content increasing from norm to 30% to the third or fourth week and then, gradual drop of gamma-globulins content to a norm from the third to the sixth disease week being the case, favorable osteomyelitis development course is predicted. Alpha-2-globulins and gamma-globulins content being in norm from the first to the eighth disease week, unfavorable osteomyelitis development course is to be predicted in children.

SUBSTANCE: method involves separating blood serum proteins into fractions, determining albumins and alpha-2-globulins content and controlling their content changes during the disease development process. Gamma-globulin content is determined in per cent ratio with respect to total protein quantity. Then, changes in the fractions content are controlled from the first to the third week. Albumin content being in norm and alpha-2-globulins content becoming greater to the end of the first week by 30-50% when compared to normal value and dropping to norm at the second week end and gamma-globulin content increasing from norm by 10-30% to the second or the third week, high inflammatory process activity is to be diagnosed. Albumin content dropping by 10-30% from normal value at the second week, alpha-2-globulins content growing by 10-20% of norm and gamma-globulin content dropping by 30-50% at the second or the third week when compared to norm, low inflammatory process activity is to be diagnosed.

SUBSTANCE: method involves determining low and middle molecular mass substances content in blood plasma and erythrocytes and general blood plasma albumin concentration. Integral index is calculated on basis of obtained values using formula II=100*S238-298(plasma)/S238-298(erythrocytes)*GAC, where S238-298(plasma) and S238-298(erythrocytes) are the low and middle molecular mass substances content in blood plasma and erythrocytes, respectively, determined from area of figures restricted by spectral curves in wavelength range of 238-298 nm and abscissa axis (conditional units2); GAC is the general blood plasma albumin concentration (g/l). The value being from 2.1 to 3.0, the first endotoxicosis degree is diagnosed. The value being from 3.1 to 4.5, the second endotoxicosis degree is diagnosed. The value being from 4.5 to 6.0, the third endotoxicosis degree is diagnosed. The value being greater than 6.0, the fourth endotoxicosis degree is diagnosed. The normal value is equal to 0.5-2.0.

SUBSTANCE: in patients one should study the content of lactoferrin in peritoneal exudates during the 1st d of postoperational period and at decreased value being below 3500 ng/ml on should predict unfavorable result. The suggested method provides correction of possible postoperational complications that deteriorate the flow of peritonitis and lead to lethal result.

SUBSTANCE: at testing one should precipitate high-molecular compounds with acetonitrile and register supernatant's spectral characteristics. Supernatant should be applied onto a paper filter, dried and put into solution containing aromatic aldehyde, acetone and concentrated hydrochloric acid taken at weight ratio of 70:5:1 to be kept for 2-3 min. Then it should be once again dried up to detect qualitative and semiquantitative content of oxidized tryptophan metabolites by intensity and chromatic shades. Moreover, by chromatic shades of yellow dyeing it is possible to detect the content of hydroxylated metabolites and by chromatic shades of violet dyeing - that of unhydroxylated ones.

SUBSTANCE: method comprises mixing blood sample to be examined with anticoagulant, placing resulting solution into vertically oriented capillary, and measuring, with equal time intervals, height of erythrocyte-free plasma layer. More specifically, blood with anticoagulant is poured by means of automatic dispensing means into hematocrit capillary, lower end of which is tightly sealed, capillary is placed vertically in centrifuge pocket, and measurement of the height of erythrocyte-free plasma layer is performed, with equal time intervals, at angular velocity not higher than 50 ppm over a specified period of time. From data obtained, one determines maximum erythrocyte sedimentation velocity value and plots corresponding graph. Proposed device contains pockets for vertically positioning capillaries with test blood dose and measuring means as well as above-mentioned centrifuge having removable rotor mounted horizontally on motor shaft and control block enabling operation of centrifuge in step-running mode and in continuous-rotation mode. Rotor is provided with peripherally arranged pockets for accommodating at least 90 capillaries.